NSG430 Exam 2 V2 | NSG 430 Adult Health
Nursing II | Grand Canyon University
This study guide is intended to help students strengthen their understanding of adult chronic
illnesses, complex medical conditions, and medical-surgical nursing interventions. The
content reflects practical nursing concepts commonly tested in adult health nursing courses.
The questions are designed to simulate actual exam conditions while reinforcing clinical
judgment, assessment skills, and therapeutic nursing interventions. Detailed expert explanations
are included to support concept mastery and exam preparedness.
════════════════════════════════════
The Exam Covers:
• Renal failure nursing care
• Dialysis concepts
• Gastrointestinal bleeding
• Endocrine emergencies
• Adult nutritional disorders
• Laboratory value interpretation
• Medication administration safety
• Nursing interventions for chronic illness
════════════════════════════════════
1. A patient with Chronic Kidney Disease (CKD) is receiving hemodialysis. Which assessment
finding is most important for the nurse to report to the provider immediately?
A. A thrill felt over the arteriovenous fistula (AVF)
B. A blood pressure reading of 150/90 mmHg
C. The absence of a thrill or bruit over the AVF site
D. A bruit heard upon auscultation of the fistula
Correct Answer: C
,Expert Explanation: The absence of a thrill or bruit indicates that the fistula has clotted
and is no longer patent. This is a medical emergency that requires immediate intervention
to restore blood flow for dialysis. The nurse must prioritize this finding over stable
hypertension or normal findings like a thrill or bruit.
2. A nurse is caring for a patient who is in the oliguric phase of Acute Kidney Injury (AKI).
Which laboratory result should the nurse expect to find?
A. Hypokalemia
B. Hyperphosphatemia
C. Both B and C
D. Hypocalcemia
Correct Answer: C
Expert Explanation: During the oliguric phase of AKI, the kidneys are unable to excrete
phosphorus, leading to hyperphosphatemia. Because of the inverse relationship between
phosphorus and calcium, the patient will also experience hypocalcemia. Monitoring these
electrolytes is crucial to prevent cardiac arrhythmias and bone mineral density loss.
3. A patient with Type 1 Diabetes Mellitus is admitted with Diabetic Ketoacidosis (DKA).
Which of the following is the priority nursing intervention?
A. Administering a rapid bolus of 50% Dextrose
B. Starting a subcutaneous long-acting insulin dose
C. Initiating IV fluid resuscitation with 0.9% Normal Saline
,D. Checking the patient’s hemoglobin A1C level
Correct Answer: C
Expert Explanation: The priority in DKA is to restore intravascular volume and improve
tissue perfusion through fluid resuscitation. Dehydration is severe in DKA due to osmotic
diuresis caused by hyperglycemia. Only after fluids are initiated is insulin typically
administered via continuous IV infusion to lower blood glucose.
4. A patient is undergoing peritoneal dialysis. The nurse notices that the outflow (effluent) is
cloudy. What is the most likely cause of this finding?
A. Normal protein loss through the membrane
B. Development of peritonitis
C. Presence of fibrin in the catheter
D. The use of a high concentration of dextrose solution
Correct Answer: B
Expert Explanation: Cloudy effluent is the primary clinical sign of peritonitis in a patient
receiving peritoneal dialysis. The nurse should immediately assess the patient for
abdominal pain and rebound tenderness. Prompt collection of a sample for culture and
sensitivity is necessary to guide antibiotic treatment.
5. Which clinical manifestation should the nurse anticipate in a patient experiencing Cushing’s
Syndrome?
A. Weight loss and hypotension
, B. Hyperkalemia and hyponatremia
C. Truncal obesity and ‘moon face’
D. Thin skin and increased muscle mass in the extremities
Correct Answer: C
Expert Explanation: Cushing’s Syndrome is characterized by an excess of glucocorticoids,
leading to a redistribution of fat in the trunk, face, and cervical spine (buffalo hump).
Patients typically exhibit hypertension and hyperglycemia rather than weight loss.
Thinning of the skin and purple striae are also common signs of cortisol excess.
6. A patient with Cirrhosis is experiencing hepatic encephalopathy. The nurse administers
lactulose (Enulose). What is the primary purpose of this medication?
A. To reduce the risk of gastrointestinal bleeding
B. To decrease serum ammonia levels via the stool
C. To increase the absorption of fat-soluble vitamins
D. To promote the excretion of excess bilirubin
Correct Answer: B
Expert Explanation: Lactulose works by acidifying the colon, which converts ammonia
into ammonium, an ion that cannot be reabsorbed into the blood. This allows the ammonia
to be excreted in the stool, thereby reducing the neurological symptoms of encephalopathy.
Nursing II | Grand Canyon University
This study guide is intended to help students strengthen their understanding of adult chronic
illnesses, complex medical conditions, and medical-surgical nursing interventions. The
content reflects practical nursing concepts commonly tested in adult health nursing courses.
The questions are designed to simulate actual exam conditions while reinforcing clinical
judgment, assessment skills, and therapeutic nursing interventions. Detailed expert explanations
are included to support concept mastery and exam preparedness.
════════════════════════════════════
The Exam Covers:
• Renal failure nursing care
• Dialysis concepts
• Gastrointestinal bleeding
• Endocrine emergencies
• Adult nutritional disorders
• Laboratory value interpretation
• Medication administration safety
• Nursing interventions for chronic illness
════════════════════════════════════
1. A patient with Chronic Kidney Disease (CKD) is receiving hemodialysis. Which assessment
finding is most important for the nurse to report to the provider immediately?
A. A thrill felt over the arteriovenous fistula (AVF)
B. A blood pressure reading of 150/90 mmHg
C. The absence of a thrill or bruit over the AVF site
D. A bruit heard upon auscultation of the fistula
Correct Answer: C
,Expert Explanation: The absence of a thrill or bruit indicates that the fistula has clotted
and is no longer patent. This is a medical emergency that requires immediate intervention
to restore blood flow for dialysis. The nurse must prioritize this finding over stable
hypertension or normal findings like a thrill or bruit.
2. A nurse is caring for a patient who is in the oliguric phase of Acute Kidney Injury (AKI).
Which laboratory result should the nurse expect to find?
A. Hypokalemia
B. Hyperphosphatemia
C. Both B and C
D. Hypocalcemia
Correct Answer: C
Expert Explanation: During the oliguric phase of AKI, the kidneys are unable to excrete
phosphorus, leading to hyperphosphatemia. Because of the inverse relationship between
phosphorus and calcium, the patient will also experience hypocalcemia. Monitoring these
electrolytes is crucial to prevent cardiac arrhythmias and bone mineral density loss.
3. A patient with Type 1 Diabetes Mellitus is admitted with Diabetic Ketoacidosis (DKA).
Which of the following is the priority nursing intervention?
A. Administering a rapid bolus of 50% Dextrose
B. Starting a subcutaneous long-acting insulin dose
C. Initiating IV fluid resuscitation with 0.9% Normal Saline
,D. Checking the patient’s hemoglobin A1C level
Correct Answer: C
Expert Explanation: The priority in DKA is to restore intravascular volume and improve
tissue perfusion through fluid resuscitation. Dehydration is severe in DKA due to osmotic
diuresis caused by hyperglycemia. Only after fluids are initiated is insulin typically
administered via continuous IV infusion to lower blood glucose.
4. A patient is undergoing peritoneal dialysis. The nurse notices that the outflow (effluent) is
cloudy. What is the most likely cause of this finding?
A. Normal protein loss through the membrane
B. Development of peritonitis
C. Presence of fibrin in the catheter
D. The use of a high concentration of dextrose solution
Correct Answer: B
Expert Explanation: Cloudy effluent is the primary clinical sign of peritonitis in a patient
receiving peritoneal dialysis. The nurse should immediately assess the patient for
abdominal pain and rebound tenderness. Prompt collection of a sample for culture and
sensitivity is necessary to guide antibiotic treatment.
5. Which clinical manifestation should the nurse anticipate in a patient experiencing Cushing’s
Syndrome?
A. Weight loss and hypotension
, B. Hyperkalemia and hyponatremia
C. Truncal obesity and ‘moon face’
D. Thin skin and increased muscle mass in the extremities
Correct Answer: C
Expert Explanation: Cushing’s Syndrome is characterized by an excess of glucocorticoids,
leading to a redistribution of fat in the trunk, face, and cervical spine (buffalo hump).
Patients typically exhibit hypertension and hyperglycemia rather than weight loss.
Thinning of the skin and purple striae are also common signs of cortisol excess.
6. A patient with Cirrhosis is experiencing hepatic encephalopathy. The nurse administers
lactulose (Enulose). What is the primary purpose of this medication?
A. To reduce the risk of gastrointestinal bleeding
B. To decrease serum ammonia levels via the stool
C. To increase the absorption of fat-soluble vitamins
D. To promote the excretion of excess bilirubin
Correct Answer: B
Expert Explanation: Lactulose works by acidifying the colon, which converts ammonia
into ammonium, an ion that cannot be reabsorbed into the blood. This allows the ammonia
to be excreted in the stool, thereby reducing the neurological symptoms of encephalopathy.
